%0 Journal Article
%T Pseudorenal Failure Secondary to Reversed Intraperitoneal Autodialysis
%A Pieter Martens
%J Case Reports in Nephrology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/982391
%X A 16-year-old boy was admitted for anuria, ascites, and abdominal pain. The patient had undergone a laparoscopic appendectomy two days prior to admission. Initial laboratory analysis revealed a plasma creatinine level of 5,07£¿mg/dL and blood urea nitrogen level of 75£¿mg/dL. Computed tomography imaging revealed diffuse abdominal ascites with normal kidneys without signs of hydronephrosis. Laprascopic revision found a 3£¿mm bladder tear and yielded an aspirate of 1,8 litre abdominal fluid. The abdominal fluid exhibited a fluid£¿:£¿serum creatinine ratio exceeding 1, indicating uroperitoneum. This case underscores the importance of bladder ruptures causing uroperitoneum presenting with azotemia. 1. Introduction Bladder rupture with the development of uroperitoneum is a rare cause of ascites, abdominal pain, and azotemia. Here, we present a case of a young man with an iatrogenic bladder rupture following laparoscopic surgery. 2. Case Report A 16-year-old presented to the emergency department with a complaint of inability to micturate, progressive abdominal dissention, and lower abdominal pain. The patient had undergone a laparoscopic appendectomy 2 days earlier and was discharged after a brief stay. Since his discharge, he was unable to micturate. His medical and surgical history is otherwise uneventful. He denies any recent trauma, alcohol use, or illicit drug use. He had been taking paracetamol and ibuprofen for postoperative discomfort. Physical examination revealed a young male in no acute distress. There was a distended abdomen, with shifting dullness. The lower abdomen quadrants were sensitive to palpation with rebound tenderness. There was no sign of globes vesicles. There was no asterixis or signs of hepatic disease. Urogenital and cardiopulmonal examination were unremarkable. Extremities were without edema. Vital signs were all within normal range (blood pressure: 115/80£¿mm£¿Hg, no orthostatic hypotension, hearth rate: 85/min, temperature: 37.1¡ãC, and respiration rate: 11/min). Laboratory analysis disclosed a plasma creatinine level of 5.07£¿mg/dL and a blood urea nitrogen level of 75£¿mg/dL, whilst creatinine and blood urea nitrogen concentration at discharge two days earlier were within normal range (creatinine level of 0.88£¿mg/dL and blood urea nitrogen level of 32£¿mg/dL.). Other laboratory results were within normal range. Abdominal ultrasound revealed diffuse abdominal ascites. There were no signs of hydronephrosis, and bladder volume was calculated to 170£¿mL. A CT-scan confirmed a significant amount of abdominal ascites. Intravesicular content
%U http://www.hindawi.com/journals/crin/2013/982391/